2017 Annual Report

The number of patients who die in hospital following an operation to repair an abdominal aortic aneurysm (AAA) continues to fall according to the National Vascular Registry 2017 annual report published today by the Vascular Society of Great Britain and Ireland (VSGBI) and the Royal College of Surgeons (RCS). Of the just over 13,000 patients who had a planned operation to repair an aneurysm between 2014 and 2016, the proportion who died in hospital after surgery was 1.4%, which represents approximately 130 patients lives saved each year compared to figures published in 2012.

In 2008, the mortality rate following elective AAA repair below the kidneys in the United Kingdom was 7%; by 2012, it had fallen to 2.4%. The results show that vascular units continue to improve the safety of the procedure, and all are performing at a similar standard of care. The Registry is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

AAA is a life threatening, but often symptom-free condition. It occurs when a bulge forms in the main blood vessel – the aorta – leading from the heart to the lower half of the body. The condition typically affects the aorta below the kidneys, and is most common in those aged over 65 years and among men. If this bulge ruptures, it causes catastrophic internal bleeding.

The report highlights, however, that although many patients received care that met the VSGBI standards on preparing patients for surgery, there are several areas for improvement. These include:

Waiting times at some hospitals are too long. While the time from vascular assessment to surgery may legitimately be many weeks for individual patients, overall the pattern of delay for individual vascular units should ideally be consistent with the 8 weeks referral to repair target.

Some vascular units are performing low numbers of AAA repairs annually. Vascular units with low volumes should work with other units and commissioners within their region to ensure they meet the minimum volumes suggested in the national service specification.

Professor Ian Loftus, a Consultant Vascular Surgeon, and lead clinician for the National Vascular Registry (NVR), said:

“It is good news that survival rates for surgery to repair abdominal aortic aneurysms continue to improve. That said, there are still too many units where patients are waiting longer than the 8-week referral to repair target. Hospitals must reflect on why these waiting times are long and what changes can be made to meet the target.”

The audit also showed that, among 4300 patients having surgery to prevent a major stroke, a significant number (44%) were not having it quickly enough.

Patients, who have suffered a mild stroke or Transient Ischaemic Attack (TIA) are at risk of having a major stroke that can lead to a serious brain injury and potentially life-changing disabilities. For some people, this risk can be reduced if they undergo surgery and the National Clinical Institute for Health and Clinical Excellence (NICE) recommends that this surgery is performed within two weeks of patients experiencing the initial symptoms.

The surgical procedure, known as carotid endarterectomy, involves removing plaque that has built-up in the carotid artery in the front of the neck. The results continue to show considerable variation in the time to intervention across NHS trusts, with 16 having an average of about 20 days.

Despite the problems of delay at some organisations, the results of the audit show that carotid surgery continues to be performed safely in the NHS, with low rates of stroke and other post-operative complications.

Professor Rob Sayers, President of the VSGBI, said:

“Overall, these results demonstrate vascular surgeons working in teams with colleagues from other specialties to bring benefits to patients. However, there is more to be done on reducing waiting times for major surgery and we must continue to re-organise vascular services so that we can deliver world class outcomes.”

The report shows vascular units are achieving good clinical outcomes and there are no outliers – performing outside the expected range – for the major surgical procedures. The good clinical outcomes reflect the shift towards centralising vascular services into larger centres where an experienced multi-disciplinary team of surgeons, stroke physicians and neurologists can assess patients presenting with stroke symptoms. The centralisation of services has been in response to growing evidence about the benefits of delivering major vascular surgery in hospitals with high caseloads.

The National Vascular Registry was established in January 2013 and is carried out by the Royal College of Surgeons and The Vascular Society of Great Britain and Ireland. It was commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme. The aim of the Registry is to provide comparative figures on the performance of vascular services in NHS hospitals to improve the quality of care patients receive. All NHS hospitals in England, Wales, Scotland and Northern Ireland are encouraged to participate in the Registry, so that it continues to support the work of the Vascular Society of Great Britain and Ireland (VSGBI) to improve the care provided by vascular services within the UK.

The results in this report are based primarily on vascular interventions that took place within the UK between 1 January 2014 and 31 December 2016.

The NVR captures data on adult patients undergoing emergency and elective procedures in NHS hospitals for the following patient groups:

patients who undergo carotid endarterectomy or carotid stenting;

patients who have a repair procedure for abdominal aortic aneurysm (AAA), both open and endovascular (EVAR); and

About the Healthcare Quality Improvement Partnership (HQIP), the Clinical Outcomes Review Programmes and how they are funded

The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programmes and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations and crown dependencies. www.hqip.org.uk/national-programme.